Has Sunlife Denied your Long-Term Disability?

Has Sunlife Denied or Terminated Your Disability Benefits?

Don’t Panic. Lalande Personal Injury Lawyers are Hamilton Long-Term Disability Lawyers who serve all of Ontario. Call 1-844-LALANDE or Send us a Message Today For a Free Consultation.

A disabling injury or illness can put your entire life on hold, from the personal to the professional. It prevents you from enjoying your life as you had and leaves you unable to work and support your household as you did before the disability.

The good news is that a mental or physical disability that prevents you from working entitles you to long-term disability benefits to cover your lost earnings due to your condition. However, many individuals face an uphill battle when seeking disability benefits from Sunlife. Receiving a claim denial prevents you from recovering benefits and halts your ability to support your household.

Disability insurance is meant to protect you and your financial welfare if you experience a health condition that prevents you from working. When you are injured, you may think that disability payments will kick in automatically. Though ideal, this is, unfortunately, not the case for everyone. Many Sun Life policyholders have found that collecting their disability benefits is not as simple as they hoped.

Disability insurance is supposed to provide you with a safety net in your time of need, but insurers are not on your side; they will do what they can to pay as little as possible. Receiving a wrongful denial can make your situation significantly worse in the short term and often has long-term implications.

If you’ve been denied long-term disability – call us today. Our Hamilton disability lawyers have been helping claimants denied long-term disability since 2003 and have recovered millions in compensation. For a free consultation with an experienced long-term disability lawyer, call Lalande Personal Injury Lawyers at 905–333-8888 or fill out a free Consultation Form today.

Alternatively, you can call us toll-free, no matter where in Canada you are located, at 1-844-525-2633. Our long-term disability lawyers would be happy to schedule a no-obligation consultation with you and your family, during which we will provide our best legal advice for your situation.

What Should I do if Sunlife Denied my Disability Benefits?

If Sunlife terminated your disability benefits, it’s important to take specific steps to address the situation effectively. Here’s a general guide on the steps to take:

1. Understand the Reason for Sunlife’s Termination: Review Sunlife’s termination letter carefully. It should state the reason for the termination of your benefits. Understanding the specific reason(s) is crucial for determining your next steps.
2. Review Your Policy: Go through your disability insurance policy to understand the terms and conditions, especially those related to the termination of benefits. This will help you assess whether the termination aligns with the policy’s provisions or if there might be grounds for contesting it.
3. Seek Legal Advice: Consider consulting our disability lawyers. We can provide guidance on your rights, help you understand the complexities of your policy, and advise you on the best course of action, whether that’s an internal appeal, filing a lawsuit, or other legal remedies. Remember – you still have options even though you’ve been denied your disability benefits. You must speak to a lawyer as soon as possible.
4. Maintain Your Health Treatment: Continue with your prescribed medical treatments and follow your doctor’s recommendations. Consistency in treatment is important both for your health and as evidence of the ongoing nature of your disability.
5. Document Communication: Keep a detailed record of all your communications with your Sunlife insurance adjuster. This can be important if there are disputes about what was communicated and when.
6. Stay Organized: Keep all your documents, correspondence, and notes organized. Quickly finding and referencing specific information can be crucial during the appeal process or legal proceedings.

Every case is unique, and the best course of action depends on the specifics of your situation, including the reason for the termination, the terms of your Sunlife insurance policy, and your medical condition. To navigate this process effectively, it’s strongly recommended you seek professional legal advice from our disability lawyers.

Why Did Sunlife Deny My Long-Term Disability Benefits?

Sunlife can deny long-term disability claims for several reasons, some of which are as follows:

1. Insufficient Medical Evidence: In Canada, long-term disability claims often require substantial medical evidence to support the claim. If the medical documentation is incomplete, vague, or does not sufficiently prove that the disability is severe enough to prevent the claimant from working, Sunlife may deny the claim.
2. Pre-Existing Conditions: Many Canadian disability insurance policies have clauses related to pre-existing conditions within the first 12 months before obtaining a disability policy. Individually purchased policies are similar. If the disability is due to or related to a condition that the claimant had before acquiring the insurance policy, and if this condition was not disclosed at the time of application, the claim may be denied.
3. Non-Compliance with Treatment Plans: If a claimant does not follow prescribed treatment plans, Sunife may view this as non-compliance and deny the claim. They may argue that the claimant is not taking necessary steps to improve their health. You must take the necessary steps to mitigate and recover from your condition.
4. Definition of Disability: The specific definition of disability, as stated in your Sunlife insurance policy, plays a crucial role. The definition of disability may change after two years (e.g., from “unable to perform your own occupation” to “unable to perform any occupation”). If you do not meet the evolving criteria, your claim can be denied whenever they believe you do not meet the definition.
5. Surveillance and Social Media: Sunife, like other insurance companies, sometimes uses surveillance tactics such as monitoring social media activities to gather evidence about the claimant’s activities. If they find evidence suggesting that the claimant is more physically capable than reported, they may use this as a basis to deny the claim.

It’s important for claimants to thoroughly understand their policy, gather comprehensive medical evidence, and adhere to their treatment plans to strengthen their long-term disability claims. Connecting with a Sun Life long-term disability insurance lawyer as soon as possible after your denial is the best thing you can do. The longer you wait, the longer you delay your claim’s recovery.

While the above reasons are all valid reasons for Sunlife to deny a claim, it’s often possible that their conclusions and assertions are untrue. For example, surveillance and social media can be taken out of context, or they can argue that you do not meet the definition of total disability when you do. This is where an experienced disability lawyer becomes invaluable; they can help you refute the insurer’s false or biased claims and prove your disability beyond a shadow of a doubt.

Should I File an Internal Appeal With Sunlife?

If your long-term disability benefits have been denied – Sunlife will offer you the option of an internal appeal. However, just because they offer it does not mean you must do it. In fact, our Hamilton disability lawyers would recommend you don’t.

Pursuing an internal appeal for denied disability benefits is not always advisable due to inherent biases and the limited scope of review within the insurance company. Sunlife employs the “appeals team” that reviews your information; thus, they are paid by the same people who denied your claim in the first place.

There are several compelling reasons why filing a lawsuit might be a better option than an internal appeal:

Bias of the Insurance Company:

• Financial Interests: The insurance company that denied the claim initially has a financial interest in maintaining that decision. This conflict of interest can influence the objectivity of the internal appeal process.
• Institutional Inertia: Companies often have an institutional tendency to uphold previous decisions. The same personnel or departments involved in the initial decision may also handle the appeal, leading to a high likelihood of the original decision being reaffirmed, even with new or additional information.

• Restriction on New Evidence: Internal appeals usually limit the review to the evidence already submitted. This can be detrimental if the initial submission lacks critical information or new supporting evidence has emerged since the original claim.
• Process Constraints: The insurance company controls the review process and criteria in internal appeals, which might not be as thorough or fair as an independent review.

Advantages of Filing a Lawsuit:

• Independent Judgment: A lawsuit brings the case before an impartial judge or jury, ensuring an independent review free from the insurance company’s internal biases and financial interests.
• Broader Evidence Review: In a lawsuit, you can introduce new evidence and testimony that wasn’t part of the original claim or internal appeal. This allows for a more comprehensive review of the case.
• Legal Precedents and Standards: Courts operate under established legal standards and precedents, which can offer a more favourable framework for claimants than an insurance company’s policies and procedures.
• Potential for Greater Compensation: A lawsuit can result in not just the approval of benefits but also the possibility of receiving back pay, interest, and sometimes even punitive damages, depending on the jurisdiction and specifics of the case.
• Legal Representation: In a lawsuit, claimants can be represented by attorneys specializing in disability law. These attorneys offer expertise and advocacy that can significantly increase the chances of a favourable outcome.

While a lawsuit can be more time-consuming and potentially more costly, for many, the prospect of an impartial review and the potential for more careful consideration of their claim makes it a more attractive option than an internal appeal. Individuals need to consult with legal professionals to understand their situation and receive tailored advice before deciding which route to approach after a Sunlife denial.

Sunlife Disability Benefits: What Happens After Two Years?

When an individual is approved for long-term disability (LTD) benefits through Sunlife, it’s essential to understand that the definition of disability may change after two years. This change in definition is a crucial aspect of the policy and can significantly impact the claimant’s eligibility for continued benefits.

During the first two years of receiving LTD benefits, the policy typically defines disability under the “own occupation” provision. This means that the claimant is considered disabled if they cannot perform the essential duties of their own specific job due to an illness or injury. The “own occupation” definition is generally more lenient, focusing solely on the claimant’s ability to perform their current job.

However, after two years, the definition of disability often shifts to the “any occupation” provision. Under this definition, the claimant is considered disabled only if they are unable to perform the duties of any occupation for which they are reasonably suited by way of education, training, or experience. This change in definition is significant because it broadens the scope of potential jobs the claimant may be expected to perform, making it more challenging to qualify for ongoing benefits.

Insurers pay close attention to this two-year mark because it allows them to reassess the claimant’s eligibility for benefits under the more stringent “any occupation” definition. From the insurer’s perspective, this shift in definition helps control costs and ensures that only those who are truly unable to work in any capacity continue to receive benefits.

It’s important to note that while the two-year mark is a critical point in the lifecycle of an LTD claim, not all insurance adjusters are acutely aware of the legal nuances surrounding this change in definition. Some adjusters may not fully grasp the implications of the shift from “own occupation” to “any occupation” or may not be well-versed in the relevant case law that has shaped the interpretation of these provisions.

This lack of understanding can lead to mishandled claims, wrongful denials, or failure to thoroughly investigate the claimant’s ability to work in other occupations. As a result, claimants may find themselves unfairly denied benefits or faced with the daunting task of appealing the insurer’s decision.

To protect their rights and ensure they receive the benefits they are entitled to, claimants should familiarize themselves with the terms of their specific policy and seek the advice of experienced disability lawyers from Lalande Personal Injury Lawyers. Our disability law experts can help navigate the complexities of this two-year juncture, gather the necessary evidence to support the claim, and advocate on behalf of the claimant to secure the benefits they deserve.

Benefit Reinstatement vs. Lump Sum Settlement: What You Need to Know

When Sunlife denies or terminates your long-term disability benefits, the initial goal is usually to have your benefits reinstated. This is a common outcome; however, you may be faced with the choice of accepting a lump sum settlement instead of pursuing reinstatement of your monthly benefits. Our Hamilton disability lawyers understand how significantly this decision can impact your future, so we will help you make the best possible decision.

Here’s a brief overview of each option:

Benefit Reinstatement:
Pursuing reinstatement means we work to have your monthly disability benefits restored by Sunlife. If successful, you’ll receive ongoing payments according to your policy terms. This option provides the long-term financial security the benefits promised you in the first place, but may involve a lengthy legal process.

Lump Sum Settlement:
A lump sum settlement is a one-time payment from Sunlife in exchange for releasing them from any further obligation to pay your disability benefits. Upon accepting, you will absolve them of any obligation to provide you with future payments. This can provide immediate financial relief and certainty, but it also means giving up your right to ongoing monthly payments.

While this can be a good decision for some, you must consider it carefully. Our Hamilton disability lawyers strongly recommend that claimants seek legal help to make this decision, as there are things you may not think of.

For example, you want to ensure the number you accept as a lump sum considers all future medical costs, the ongoing impact on your career, and more. An experienced Hamilton disability lawyer will help you include every aspect of your situation and ensure you receive the maximum lump sum you are entitled to.

Some important factors to consider when contemplating a lump sum include:

• Financial Needs: Assess your current and future financial needs. A lump sum can help pay off debts or invest, while reinstatement provides steady income.
• Health Outlook: Consider your prognosis and expected duration of disability. A lump sum may be preferable for shorter-term disabilities, while reinstatement better suits longer-term conditions.
• Legal Strength: Evaluate the strength of your case with your Hamilton disability lawyer. A strong case for reinstatement may be worth pursuing over a settlement.
• Risk Tolerance: Litigation carries inherent risks. A settlement offers guaranteed funds, while reinstatement depends on the outcome of your case.
• Tax Implications: Lump sum settlements are generally taxable as income in the year received. Monthly disability benefits are typically tax-free.
• Future Insurability: Accepting a settlement may impact your ability to obtain disability coverage in the future.

Deciding between a lump sum settlement and pursuing benefit reinstatement is a complex choice with significant implications for your future. Consulting with an experienced Hamilton disability lawyer will help you understand your options and make an informed decision based on your unique circumstances.

How Long Do I Have to File a Legal Claim Against Sunlife?

In Ontario, Canada, the time frame within which a claimant must file a legal claim following the denial of long-term disability benefits is typically governed by a two-year limitation period. This means that a claimant usually has two years from the date they are first informed of the denial to initiate legal proceedings.

However, there are important nuances to consider:

1. Date of Discovery: The two-year limitation period generally starts from the date the claimant first became aware, or ought to have become aware, of the facts upon which the legal claim is based. In the case of disability benefit denials, this is often the first date the insurer formally notifies the claimant of the denial – remember the term is “formally”.
2. Exceptions and Extensions: Although rare, the limitation period can be extended or delayed in certain circumstances, such as in cases of disability or other factors that prevent the claimant from understanding their legal rights. However, these are specific legal exceptions and should be discussed with a lawyer.
3. Impact of Appeals: If you are engaging in internal appeals with Sunlife, be aware that this process does not extend the limitation period for filing a lawsuit. Therefore, keeping track of the limitation period while undergoing any appeal process with the insurer is crucial.

Given the complexity of these matters and the significant impact of missing a limitation deadline, it’s highly advisable to consult with our disability lawyers, who specialize in disability insurance claims, as soon as possible after a Sunlife denial. Our legal professionals can provide advice tailored to your specific situation, including the relevant limitation periods and any actions you need to take.

Has Sunlife Denied Your Long-Term Disability Benefits? Our Hamilton Disability Lawyers Can Help

If Sunlife has denied your long-term disability benefits, it’s crucial to seek the guidance of an experienced long-term disability lawyer to navigate the complexities of your claim and secure the compensation you deserve. At Lalande Personal Injury Lawyers, we understand the profound impact such a denial can have on your life and are committed to advocating for your rights.

Here’s what you can do:

1. Contact Us Immediately: Time is of the essence in disability claims. Reach out to us for a free consultation to discuss your case. You can call us at 905-333-8888 without worrying about upfront fees.
2. Gather Your Documentation: Prepare all relevant documents related to your disability claim, including any denial letters from the insurance company, medical records, and any correspondence you have had regarding your claim.
3. Meet with Our Team: We can meet with you in person at our Downtown Hamilton office or virtually via Zoom, Google Meet, Microsoft Teams, or Facetime, depending on what’s most convenient for you.

We operate on a contingency basis, meaning you only pay if we successfully recover funds for you. When you work with us, you get one-on-one attention. You will not be passed around; you will work directly with our dedicated team throughout your case.

If you’re ready to start, you can also send us a confidential email through our website and we will be happy to get right back to you. We are here to provide you with the personalized and effective representation you need during this challenging time.